Summer Day Camp 2016 Registration Form

The Program:  
CHAT will be hosting our 8th annual Summer Day Camp. There will be recreation, games, contests, team­ building activities, crafts, Bible instruction, lunch, and field trips.

$20/participant for families making less than $35,000
$100/participant for families making $35,000­$50,000
$300/participant for families making $50,000­$70,000
$600/participant for families making more than $70,000
*Any additional siblings are half price
*W­2’s may be required for income verification

Kindergarten ­ Rising 8th Graders.

The Commitment:
June 21 – July 29
Tuesday – Friday
11am – 4pm

Leigh St. Baptist Church
517 North 25th Street

Please complete the form below to register for summer day camp 2016
students already enrolled in chat programming are given priority over students not yet enrolled. if your child is not currently enrolled in a chat program, you may still fill out the form below. chat staff will contact you to let you know if space is available.
Student Name *
Student Name
Date of Birth *
Date of Birth
Phone Number *
Phone Number
If none, please indicate that.
Registration form and money are due by Wednesday, June 1st to The Lighthouse (601 North 31st Street).
Date *